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Why Healthy Women May Need as Much Testosterone as Estrogen

Women Need Testosterone Too

If you have been researching women’s hormones, you may have finally come across testosterone therapy for women. 

Traditionally, estrogen has been considered the women’s hormone and testosterone was thought of as the male sex hormone. This view is still widespread today. But men and women have the same primary sex hormones: testosterone, estrogen, and progesterone, and each can provide benefits to both sexes. 

Men require a much higher amount of testosterone for optimal health than women. Because of this, the importance of testosterone for women is often overlooked or considered insignificant. Consequently, testosterone may be excluded entirely from discussions of women’s hormone replacement therapy.

We are well versed that proper women’s hormonal health requires adequate estrogen levels. However, testosterone is essential for women’s health as well. In fact, for optimal women’s health, women require similar, and sometimes greater blood concentrations of testosterone compared to estrogen within themselves. 

If women need similar amounts of estrogen as they do testosterone, why do testosterone labs look so much smaller?

This is a valid question and the answer explains a lot of the confusion. Many labs report testosterone in ng/dl. Major blood work companies such as LabCorp use a young adult women’s total testosterone reference range of between 13 and 71 ng/dl. 

Conversely, women’s estradiol (the primary form of estrogen) is reported in pg/ml and can range from 12.5 pg/ml to 498 pg/mL in premenopausal women, depending on where the woman is in her menstrual cycle. In addition to this, a woman’s highest levels of estradiol are during ovulation, which is a short period, lasting just about one day. The rest of the time, during women’s follicular and luteal phases, we expect estradiol levels to be at their highest 166 and 211 pg/ml respectively.

In short, testosterone labs can look “smaller” than estrogen labs mainly because they’re often reported in different units and because estradiol naturally rises and falls throughout the menstrual cycle. When you compare the hormones in context, women still need both estrogen and testosterone in meaningful amounts – it’s the lab format and timing that can make testosterone appear much lower at first glance.

Women’s Testosterone Levels Can Surpass Their Estrogen Levels

If we used the same measurements for testosterone and estradiol, we would find that women should have a total testosterone of 130 to 710 pg/mlL. Compare this to women’s upper limit of 166 to 211 pg/ml the majority of the month, women’s total testosterone can be double to triple their estrogen levels.

When we use the same reference range values, we can see that healthy women will often have more testosterone than estrogen circulating in our blood. Understanding that testosterone can be the highest concentrated sex hormone in the blood, we can see how testosterone can play just as important for women as estrogen.

How do I know if I am testosterone deficient?

If we need nearly the same concentrations of testosterone as estrogen, there will likely be signs if you are not making enough testosterone on your own. Like men, women rely on testosterone to improve their mood, sexual function, energy, healthy body mass, and sexual desire. 

If your energy is lacking luster, weight continuously goes on easier and is more reluctant coming off, and if there is a lack of sexual desire, you should consider consulting a healthcare provider trained in all of women’s sex hormones, including testosterone.

Putting the pieces together

A well trained healthcare provider will assess your symptoms, history, and review blood work to assess for testosterone deficiency and consult you on hormone therapy. 

When reviewing labs, it is important to note that total testosterone cannot tell the whole story. This is because symptoms of testosterone deficiency can occur for a myriad of reasons:

  • You may not make enough testosterone, which will be indicated by a low testosterone. 
  • Your body also may not be able to access the testosterone it has produced. This can be indicated by a low free testosterone and a raised sex hormone binding globulin.
  • Your body may make enough testosterone but may be resistant to responding to the hormone at a cellular level. This is difficult to identify with labs alone and requires a skilled practitioner to identify.

Could Birth Control Contribute to Symptoms of Low Testosterone?

Difficulty accessing testosterone is a common problem as this is especially prevalent in women who have taken oral contraceptives. Even if you took birth control for just a small interval, years ago, it can still impact your hormonal health today, as it often causes an irreversible elevation in sex hormone binding globulin (SHBG) due to its processing in the liver, where SHBG is produced. SHBG is the protein that holds onto our sex hormones as they travel throughout the body, and when the levels are too high, it can lower the amount of usable hormones, including testosterone that is available. Even a slightly high total testosterone may be rendered useless by higher amounts of SHBG.

We are Here to Help

Our healthcare providers are experts in testosterone therapy. Our practitioners can assess for testosterone deficiency and discuss the risks and the benefits of adding testosterone therapy to your hormone replacement by reviewing your personal and health history, your symptoms, and reviewing your blood work. This includes evaluating for a low free testosterone that can remain hidden with a total testosterone lab alone.

If you are curious about your hormone levels or can relate to feelings of lethargy, low libido, and weight gain, our healthcare professionals are here to help. Contact our team today to learn more about the benefits and safety of hormone therapy.

Talk to an experienced healthcare provider today

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*This content is for educational purposes only and is not intended as medical advice. Testosterone therapy may not be appropriate for everyone. Treatment decisions should be made in consultation with a qualified healthcare provider based on individual health history and lab results

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